Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy

Rana R. McKay, Nils Kroeger, Wanling Xie, Jae Lyun Lee, Jennifer J. Knox, Georg A. Bjarnason, Mary J. MacKenzie, Lori Wood, Sandy Srinivas, Ulka N. Vaishampayan, Sun Young Rha, Sumanta K. Pal, Frede Donskov, Srinivas K. Tantravahi, Brian I. Rini, Daniel Y.C. Heng, Toni K. Choueiri

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Abstract

Background The skeleton and liver are frequently involved sites of metastasis in patients with metastatic renal cell carcinoma (RCC). Objective To analyze outcomes based on the presence of bone metastases (BMs) and/or liver metastases (LMs) in patients with RCC treated with targeted therapy. Design, setting, and participants We conducted a review from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) of 2027 patients with metastatic RCC. Outcome measurements and statistical analysis We analyzed the impact of the site of metastasis on overall survival (OS) and time-to-treatment failure. Statistical analyses were performed using multivariable Cox regression. Results and limitations The presence of BMs was 34% overall, and when stratified by IMDC risk groups was 27%, 33%, and 43% in the favorable-, intermediate-, and poor-risk groups, respectively (p < 0.001). The presence of LMs was 19% overall and higher in the poor-risk patients (23%) compared with the favorable- or intermediate-risk groups (17%) (p = 0.003). When patients were classified into four groups based on the presence of BMs and/or LMs, the hazard ratio, adjusted for IMDC risk factors, was 1.4 (95% confidence interval [CI], 1.22-1.62) for BMs, 1.42 (95% CI, 1.17-1.73) for LMs, and 1.82 (95% CI, 1.47-2.26) for both BMs and LMs compared with other metastatic sites (p < 0.0001). The prediction model performance for OS was significantly improved when BMs and LMs were added to the IMDC prognostic model (likelihood ratio test p < 0.0001). Data in this analysis were collected retrospectively. Conclusions The presence of BMs and LMs in patients treated with targeted agents has a negative impact on survival. Patients with BMs and/or LMs may benefit from earlier inclusion on clinical trials of novel agents or combination-based therapies.

Original languageEnglish
Pages (from-to)577-584
Number of pages8
JournalEuropean Urology
Volume65
Issue number3
DOIs
Publication statusPublished - 2014 Mar 1

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Renal Cell Carcinoma
Neoplasm Metastasis
Bone and Bones
Liver
Therapeutics
Confidence Intervals
Survival
Treatment Failure
Skeleton

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

McKay, R. R., Kroeger, N., Xie, W., Lee, J. L., Knox, J. J., Bjarnason, G. A., ... Choueiri, T. K. (2014). Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. European Urology, 65(3), 577-584. https://doi.org/10.1016/j.eururo.2013.08.012
McKay, Rana R. ; Kroeger, Nils ; Xie, Wanling ; Lee, Jae Lyun ; Knox, Jennifer J. ; Bjarnason, Georg A. ; MacKenzie, Mary J. ; Wood, Lori ; Srinivas, Sandy ; Vaishampayan, Ulka N. ; Rha, Sun Young ; Pal, Sumanta K. ; Donskov, Frede ; Tantravahi, Srinivas K. ; Rini, Brian I. ; Heng, Daniel Y.C. ; Choueiri, Toni K. / Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. In: European Urology. 2014 ; Vol. 65, No. 3. pp. 577-584.
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title = "Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy",
abstract = "Background The skeleton and liver are frequently involved sites of metastasis in patients with metastatic renal cell carcinoma (RCC). Objective To analyze outcomes based on the presence of bone metastases (BMs) and/or liver metastases (LMs) in patients with RCC treated with targeted therapy. Design, setting, and participants We conducted a review from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) of 2027 patients with metastatic RCC. Outcome measurements and statistical analysis We analyzed the impact of the site of metastasis on overall survival (OS) and time-to-treatment failure. Statistical analyses were performed using multivariable Cox regression. Results and limitations The presence of BMs was 34{\%} overall, and when stratified by IMDC risk groups was 27{\%}, 33{\%}, and 43{\%} in the favorable-, intermediate-, and poor-risk groups, respectively (p < 0.001). The presence of LMs was 19{\%} overall and higher in the poor-risk patients (23{\%}) compared with the favorable- or intermediate-risk groups (17{\%}) (p = 0.003). When patients were classified into four groups based on the presence of BMs and/or LMs, the hazard ratio, adjusted for IMDC risk factors, was 1.4 (95{\%} confidence interval [CI], 1.22-1.62) for BMs, 1.42 (95{\%} CI, 1.17-1.73) for LMs, and 1.82 (95{\%} CI, 1.47-2.26) for both BMs and LMs compared with other metastatic sites (p < 0.0001). The prediction model performance for OS was significantly improved when BMs and LMs were added to the IMDC prognostic model (likelihood ratio test p < 0.0001). Data in this analysis were collected retrospectively. Conclusions The presence of BMs and LMs in patients treated with targeted agents has a negative impact on survival. Patients with BMs and/or LMs may benefit from earlier inclusion on clinical trials of novel agents or combination-based therapies.",
author = "McKay, {Rana R.} and Nils Kroeger and Wanling Xie and Lee, {Jae Lyun} and Knox, {Jennifer J.} and Bjarnason, {Georg A.} and MacKenzie, {Mary J.} and Lori Wood and Sandy Srinivas and Vaishampayan, {Ulka N.} and Rha, {Sun Young} and Pal, {Sumanta K.} and Frede Donskov and Tantravahi, {Srinivas K.} and Rini, {Brian I.} and Heng, {Daniel Y.C.} and Choueiri, {Toni K.}",
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McKay, RR, Kroeger, N, Xie, W, Lee, JL, Knox, JJ, Bjarnason, GA, MacKenzie, MJ, Wood, L, Srinivas, S, Vaishampayan, UN, Rha, SY, Pal, SK, Donskov, F, Tantravahi, SK, Rini, BI, Heng, DYC & Choueiri, TK 2014, 'Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy', European Urology, vol. 65, no. 3, pp. 577-584. https://doi.org/10.1016/j.eururo.2013.08.012

Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. / McKay, Rana R.; Kroeger, Nils; Xie, Wanling; Lee, Jae Lyun; Knox, Jennifer J.; Bjarnason, Georg A.; MacKenzie, Mary J.; Wood, Lori; Srinivas, Sandy; Vaishampayan, Ulka N.; Rha, Sun Young; Pal, Sumanta K.; Donskov, Frede; Tantravahi, Srinivas K.; Rini, Brian I.; Heng, Daniel Y.C.; Choueiri, Toni K.

In: European Urology, Vol. 65, No. 3, 01.03.2014, p. 577-584.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy

AU - McKay, Rana R.

AU - Kroeger, Nils

AU - Xie, Wanling

AU - Lee, Jae Lyun

AU - Knox, Jennifer J.

AU - Bjarnason, Georg A.

AU - MacKenzie, Mary J.

AU - Wood, Lori

AU - Srinivas, Sandy

AU - Vaishampayan, Ulka N.

AU - Rha, Sun Young

AU - Pal, Sumanta K.

AU - Donskov, Frede

AU - Tantravahi, Srinivas K.

AU - Rini, Brian I.

AU - Heng, Daniel Y.C.

AU - Choueiri, Toni K.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Background The skeleton and liver are frequently involved sites of metastasis in patients with metastatic renal cell carcinoma (RCC). Objective To analyze outcomes based on the presence of bone metastases (BMs) and/or liver metastases (LMs) in patients with RCC treated with targeted therapy. Design, setting, and participants We conducted a review from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) of 2027 patients with metastatic RCC. Outcome measurements and statistical analysis We analyzed the impact of the site of metastasis on overall survival (OS) and time-to-treatment failure. Statistical analyses were performed using multivariable Cox regression. Results and limitations The presence of BMs was 34% overall, and when stratified by IMDC risk groups was 27%, 33%, and 43% in the favorable-, intermediate-, and poor-risk groups, respectively (p < 0.001). The presence of LMs was 19% overall and higher in the poor-risk patients (23%) compared with the favorable- or intermediate-risk groups (17%) (p = 0.003). When patients were classified into four groups based on the presence of BMs and/or LMs, the hazard ratio, adjusted for IMDC risk factors, was 1.4 (95% confidence interval [CI], 1.22-1.62) for BMs, 1.42 (95% CI, 1.17-1.73) for LMs, and 1.82 (95% CI, 1.47-2.26) for both BMs and LMs compared with other metastatic sites (p < 0.0001). The prediction model performance for OS was significantly improved when BMs and LMs were added to the IMDC prognostic model (likelihood ratio test p < 0.0001). Data in this analysis were collected retrospectively. Conclusions The presence of BMs and LMs in patients treated with targeted agents has a negative impact on survival. Patients with BMs and/or LMs may benefit from earlier inclusion on clinical trials of novel agents or combination-based therapies.

AB - Background The skeleton and liver are frequently involved sites of metastasis in patients with metastatic renal cell carcinoma (RCC). Objective To analyze outcomes based on the presence of bone metastases (BMs) and/or liver metastases (LMs) in patients with RCC treated with targeted therapy. Design, setting, and participants We conducted a review from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) of 2027 patients with metastatic RCC. Outcome measurements and statistical analysis We analyzed the impact of the site of metastasis on overall survival (OS) and time-to-treatment failure. Statistical analyses were performed using multivariable Cox regression. Results and limitations The presence of BMs was 34% overall, and when stratified by IMDC risk groups was 27%, 33%, and 43% in the favorable-, intermediate-, and poor-risk groups, respectively (p < 0.001). The presence of LMs was 19% overall and higher in the poor-risk patients (23%) compared with the favorable- or intermediate-risk groups (17%) (p = 0.003). When patients were classified into four groups based on the presence of BMs and/or LMs, the hazard ratio, adjusted for IMDC risk factors, was 1.4 (95% confidence interval [CI], 1.22-1.62) for BMs, 1.42 (95% CI, 1.17-1.73) for LMs, and 1.82 (95% CI, 1.47-2.26) for both BMs and LMs compared with other metastatic sites (p < 0.0001). The prediction model performance for OS was significantly improved when BMs and LMs were added to the IMDC prognostic model (likelihood ratio test p < 0.0001). Data in this analysis were collected retrospectively. Conclusions The presence of BMs and LMs in patients treated with targeted agents has a negative impact on survival. Patients with BMs and/or LMs may benefit from earlier inclusion on clinical trials of novel agents or combination-based therapies.

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U2 - 10.1016/j.eururo.2013.08.012

DO - 10.1016/j.eururo.2013.08.012

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